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Addressing Childhood Obesity:

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Smart kids graduate from high school. High school graduates (with some additional education) live healthier and ... How will Loveland reduce childhood obesity ? ... – PowerPoint PPT presentation

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Title: Addressing Childhood Obesity:


1
  • Addressing Childhood Obesity
  • Fit Kids are Smart Kids
  • Thompson School Distict Wellness Workshop
  • Eduardo Sanchez, MD,MPH,FAAFP
  • Vice President and Chief Medical Officer
  • BlueCross and BlueShield of Texas
  • September 28, 2009

2
Start with the conclusion
  • Fit Kids are Smart Kids
  • Smart kids graduate from high school
  • High school graduates (with some additional
    education) live healthier and value education
  • High school graduates have fit, smart kids

3
The Childhood Obesity Epidemic
  • 16.3 of children and adolescents are obese in
    U.S. (one in six)
  • Obesity rates have tripled in the last 30 years
  • While all children are increasingly obese, the
    poor, African Americans, Latinos, American
    Indians, and Pacific Islanders are
    disproportionately more overweight and obese.

4
The Childhood Obesity Epidemic
SOURCE CDC, NHANES
5
Prevalence of BMI gt 85 in Boys(Ogden,2008,
JAMA, 299(20), 2401-2405.)
6
Prevalence of BMI gt 85 in Girls(Ogden,2008,
JAMA, 299(20), 2401-2405.)
7
Colorado Health Survey (2004)
  • 14 percent of Colorado children ages 2-14 were
    overweight
  • 15 percent of Colorado children ages 2-14 were
    obese
  • Obesity is more prevalent among poor children and
    non-White children.

8
F as in fat 2009 (2007 National
Survey of Childrens Health)
  • 27.2 percent of Colorado children ages 10 - 17
    were overweight and obese
  • 27.6 percent of Colorado children ages 6-17
    participate in vigorous physical activity every
    day

9
Consequences of Childhood Obesity
  • May reduce life expectancy
  • More likely to develop hypertension, type-2
    diabetes, and high cholesterol
  • Reduced quality of life
  • Higher medical expenses
  • Higher risk of adult obesity

10
Creating Healthy Environments
  • Children and parents need healthy environments to
    make healthy choices
  • Many children live in places where the unhealthy
    choice is the easy choice

11
Child population percentages by race in Colorado
  • Race 2003 2004 2005 2006 2007
  • Non-Hispanic White 64 63 62 62 61
  • Non-Hispanic Black 4 4 4 4 4
  • Non-Hispanic Asian 2 2 2 2 3
  • Non-H 2 or More Races 3 3 3 3 3
  • Hispanic or Latino 26 26 27 28 28
  • Source Kids Count Data Center

12
Colorado Students Qualifying for Free or Reduced
Price Lunch by School District (percent)
  • Poverty level 2000 2003 2007
  • Eligible for Free Lunch 20 24 27
  • Eligible for Reduced Price Lunch 7 6 7
  • Total 27 30 34
  • Source Kids Count Data Center

13
Colorado High School Graduation Rates by Race
(percent)
  • Race 2007
  • Black Students 65.4
  • Native American Students 58.9
  • Asian Students 83.5
  • Hispanic Students 57.1
  • White Students 82.1
  • Source Kids Count Data Center

14
Causes of Death, United States 2005
26.6
Diseases of the heart
22.8
All cancers
5.9
Stroke
5.3
Chronic lower respiratory disease
4.8
Unintentional injuries
Diabetes mellitus
3.1
Alzheimers disease
2.9
Influenza and pneumonia
1.8
1.4
Septicemia
0
9
18
27
36
Source cdc.gov
15
Underlying Causes of Death, U.S. 2000
Source Mokdad A, Marks JS, Stroup DE, Gerberding
JL. Actual causes of death in the United States.
JAMA 2004 291(10)1238-1245. Correction
published JAMA 2005 293(3) 293-294.
16
The Preventable Causes of Death in the United
StatesComparative Risk Assessment of Dietary,
Lifestyle, and Metabolic Risk Factors
(Danaei,2009)
Deaths attributable to individual risk
(thousands) in both sexes
17
Age adjusted death rates among 25-64 year olds
(per 100,000) by educational attainment (2005)
CDC
18
Age adjusted death rates among 25-64 year olds
(per 100,000) by educational attainment (2005)
CDC
19
Trends in U.S. Smoking High School Seniors and
Adults (19652004)
DSHS
20
Three Disturbing Trends
Obesity and Diabetes CDC NHANES
Expenditures CMS, Health 2004
21
The cost of obesity
  • Medical costs related to obesity in America in
    2008 may be as high as 147 billion.
  • Average annual medical costs
  • Health weight - 3400
  • Obese - 4900

22
Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 20
23
Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
24
Obesity Trends Among U.S. AdultsBRFSS, 2008
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
25
Low Obesity Prevalence, BRFSS, 2007
  • Colorado 18.7
  • Connecticut 21.2
  • Massachusetts 21.3
  • Vermont 31.3
  • Hawaii 21.4
  • Rhode Island 21.4

26
2007 National Diabetes Facts
  • Race and ethnic differences in prevalence of
    diagnosed diabetes
  • 6.6 of non-Hispanic whites
  • 7.5 of Asian Americans
  • 10.4 of Hispanics
  • 8.2 for Cubans
  • 11.9 for Mexican Americans
  • 12.6 for Puerto Ricans
  • 11.8 of non-Hispanic blacks

CDC government
27
Two possible futures
  • Scenario one
  • Overweight or obese middle and young adults
    competing with elderly baby boomers for limited
    health resources

28
Two possible futures
  • Scenario two
  • Healthy Çoloradoans eating smart, being active
    and reducing the demand for expensive health
    resources

29
Obesity Prevalence Among 4thGrade Texans
2000-2002
2004-2005
Obesity is gt 95th Percentile for BMI by Age/Sex
4th Grade Prevalence of Overweight by Health
Service Region, SPAN, 2000-2002 to 2004-2005
30
What Caused the Decrease in Overweight Among 4th
Graders in Regions 9 10?
  • Paso del Norte Health Foundation
  • CATCH initiative
  • 8 years
  • Resources, support
  • Qué Sabrosa Vida
  • Walk El Paso
  • Legislation
  • Senate Bills 19, 42, 530
  • Other Policies
  • Texas Public School Nutrition Policy

31
Average BMI
32
Why the difference?
  • Higher PE time in EP 14-22 min/week
  • Higher PE time in EP 60 min/week
  • Higher MVPA 10
  • Higher adoption CSHP 25
  • Higher district central planning 20
  • 5 year, 10 million investment by Paso del Norte
    Health Foundation CATCH funding ended in 2005

33
But theres more
  • Not only does CATCH improve diet, physical
    activity and obesity, but Texas researchers have
    documented significant improvements on Stanford
    Achievement test scores.
  • Among a group of predominantly poor, Latino
    elementary school students, the CATCH classroom
    physical activity intervention produced
    significant increases in achievement in math
    problem-solving.
  • Among children identified as not adapting well to
    school, CATCH produces significant improvements
    in Stanford Math and Reading scores.
  • Personal communication Dr. Nancy Murray,
    University
  • of Texas, School of Public Health.

34
Texas Education Agency Releases FITNESSGRAM
Results
  • Released by the TEA - March 9, 2009 AUSTIN
  • A first-of-its-kind study of more than 2.4
    million Texas students found that students who
    are physically fit are
  • More likely to do well on the state's
    standardized tests
  • More likely to have good school attendance
  • Less likely to have disciplinary referrals

35
National and Arkansas Childhood Obesity Trends
NHANES data sources Ogden et al. Prevalence and
Trends in Overweight Among US Children and
Adolescents, 1999-2000. JAMA 2002288(14)1728-173
2. Ogden et al. Prevalence of Overweight and
Obesity in the United States, 1999-2004. JAMA
2006295(13)1549-1555.
36
UAMS College of Public Health Evaluation of Act
1220 (2006)
  • Parents awareness of obesity-related health
    problems increased (1/3 recognized problem gt2/3)
  • 95 of parents read some or all of the Child
    Health Report and 67 found the report helpful
  • No feared consequences of BMI measurements
  • Measurable change occurring
  • Families reducing consumption of chips, soda,
    sweets
  • Younger children reducing soda consumption
  • Teens reducing vending purchases at school
  • Teens increased amount of physical activity
  • No increase in physical education time
  • Innovations in schools and communities across the
    state - taste tests in cafeterias, curriculum
    changes
  • Parental support of improved cafeteria options

Fay W. Boozman College of Public Health Year Two
Evaluation Arkansas Act 1220 of 2003 to Combat
Childhood Obesity. http//www.uams.edu/coph/repor
ts/Act1220Eval.pdf. Accessed 27 March, 2006
37
MEND
Mind Exercise Nutrition Do it!
38
Mission
To enable a significant, measurable and sustained
reduction in overweight and obesity
  • We partner across sectors to achieve this
    mission
  • Foundations / Third sector
  • Academia
  • Companies
  • Government

39
A cost-effective solution
  • Not only a high-quality out-of-school program
  • Low staff/child ratio (typically 110)
  • High participation rates (gt70)
  • Highly qualified staff (4-day training)
  • Also an evidence-based child obesity intervention
    proven to reduce BMI and waist circumference
  • Cost-effective first-line community prevention
    and treatment
  • 350 - 750 per family / program
  • Meets Wallace Foundation Jan 09 Report
    criteria
  • depends on volume to achieve economies of scale

40
1st UK RCT results a foundation for healthy
living
n104-82, 57 girls, 52 Caucasian, mean age
10.1, mean BMI z-score 2.8, 63.5 manual /
unemployed
41
How will TSD prevent and reverse childhood
obesity in its schools?
  • Good food (healthy, green, just, and affordable)
    most of the time
  • Science-based dietary guidelines for all foods in
    schools
  • Fresh fruits and vegetables
  • Universal school breakfast/lunch
  • Farm to School
  • School gardens
  • Classroom teaching about good eating
  • 30 minutes per day physical activity in schools
    HHS guidelines released 2009
  • Universal coordinated school health programs
  • No child left behind 100 high school
    graduation

42
TSD Employee Wellness
  • Potential Benefits of School Employee Wellness
    Programs
  • Decreased employee absenteeism
  • Lower health care and insurance costs
  • Increased employee retention
  • Improved employee morale
  • Fewer work-related injuries
  • Fewer worker compensation and disability claims
  • Attractiveness to prospective employees
  • Positive community image
  • Increased productivity
  • Increased motivation to teach about health
  • Increased motivation to practice healthy
    behaviors
  • Healthy role models for students

43
How will Loveland reduce childhood obesity ?
  • Develop and standardize health/nutrition
    guidelines for FNS/SNAP/WIC
  • Summer food programs for eligible children
  • Community access to good food healthy, green,
    just, and affordable
  • Water over soda
  • No child left inside
  • Community access to recreation facilities
    playgrounds, parks, trails
  • Walkable communities sidewalks, lighting, and
    traffic calmimg

44
The Role of Local Government
  • Local government is uniquely positioned to create
    healthy environments for children
  • Already experienced in promoting childrens
    health
  • Already have jurisdiction of many aspects of
    daily life

45
Health Equity
  • Health equity is the fair distribution of health
    determinants, outcomes, and resources within and
    between segments of the population, regardless of
    social standing1
  • Many individuals do not have the resources or
    opportunities to eat more fruits and vegetables
    and be more physically active.
  • Local governments can change peoples
    environments to provide equal access to factors
    that determine health

1CDC Health Equity Working Group
46
12 Most Promising Action Steps
  • Attract supermarkets and grocery stores to
    underserved neighborhoods
  • Require menu labeling in chain restaurants
  • Mandate and implement strong nutrition standards
    for foods and beverages in government-run or
    regulated after-school programs

47
12 Most Promising Action Steps
  • Adopt building codes to require access to, and
    maintenance of water fountains
  • Implement a tax strategy to discourage
    consumption of foods and beverages that have
    minimal nutritional value
  • Develop media campaigns to promote healthy eating
    and active living

48
12 Most Promising Action Steps
  • Plan, build, and maintain a network of sidewalks
    and street crossings that creates a safe and
    comfortable walking environment and that connects
    to destinations
  • Adopt community policing strategies that improve
    safety and security of streets and parks
  • Develop and implement a Safe Routes to School
    program

49
12 Most Promising Action Steps
  • Build and maintain parks and playgrounds that are
    safe and attractive for playing, and close to
    residential areas
  • Establish joint use of facilities agreements
    allowing playing fields, playgrounds, and
    recreation centers to be used when schools are
    closed
  • Institute policies mandating minimum play space,
    physical equipment, and duration of play in
    preschool, after-school, and child-care programs
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